Autologous Hematopoietic Cell Transplantation In Multiple Myeloma Patients Age 70 Years and Older.

High dose chemotherapy followed by autologous hematopoietic cell transplantation (auto HCT) for multiple myeloma (MM) has shown improved survival compared to conventional chemotherapy. However, the larger clinical trials evaluating the role of auto HCT in MM have included patients who are generally younger than 65 years. Here we report the results of MM patients, age ≥70 years, who received auto HCT at our institution.

We retrospectively analyzed 84 patients, who underwent auto HCT between January 1999 and June 2010 at MDACC. Conditioning regimen was Melphalan 140 mg/m² (MEL 140) (N=9), 180 mg/m² (MEL 180) (N=20), and 200 mg/m² (MEL 200) (N=55). Disease response was assessed at day 100 post transplant.

Pertinent patient and disease characteristics are summarized in the Table. Median age at transplant was 72 (70-80) years. Median number of prior treatments was 1 (range: 1–8). Median time from diagnosis to transplant was 8.5 (2.4-151) months. No patient was in CR prior to auto HCT. Median CD34+ cell count and TNC was 4.56 (0.72-11.1) × 10⁶/kg and 10.53 (2.25-57) ×10⁸/kg, respectively. Median follow up is 2 (0.1-7.3) years. Grade III-IV organ toxicity was seen in 35 (51%) patients. Grade III-IV toxicity in patients who received MEL 140, MEL 180, and MEL 200 was 25%, 45%, and 44%, respectively (p value > 0.05). Non-relapse mortality (NRM) at 100 days was 2%. Two patients died in first 100 days. Disease response in evaluable patients (N=79) at day 100 was: CR=15 (19%); VGPR=7 (9%); PR=41 (52%); and SD=10 (13%). Median progression free survival (PFS) and overall survival (OS) from auto HCT was 2.1 years (95% CI 1.78–3.69) and 5.6 years (95% CI 5.51-NA), respectively. 2-year PFS and OS were 56% (95% CI 0.44–0.71) and 80% (95% CI 0.7–0.91), respectively. There was no difference in NRM, PFS, or OS in different MEL groups. Similarly there was no difference in TRM, PFS, and OS in patients ≥ 75 years compared to the patients < 75 years.

Auto HCT in myeloma patients age ≥ 70 years is safe and feasible. Toxicity, NRM, response and survival were comparable to younger myeloma patients. The age alone should not be a contraindication for auto HCT.

Shah:Celgene: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Millenium: Research Funding; Novartis: Research Funding. Orlowski:Celgene: Consultancy, Research Funding; Millennium Pharmaceuticals, Inc.: Consultancy, Research Funding. Weber:Novartis-unpaid consultant: Consultancy; Merck- unpaid consultant: Consultancy; Celgene- none for at least 2 years: Honoraria; Millenium-none for 2 years: Honoraria; Celgene, Millenium, Merck: Research Funding. Giralt:Celgene: Honoraria, Speakers Bureau; Millenium: Honoraria, Speakers Bureau.